Trial design and protocol of randomized controlled trial comparing the efficacy of combined letrozole and clomiphene versus only letrozole as a method of ovulation induction in women with polycystic ovarian syndrome (CCLOP trial)
DOI:
https://doi.org/10.18203/2349-3259.ijct20221874Keywords:
Clomiphene, Letrozole, Polycystic ovarian syndrome, Ovulation inductionAbstract
Background: Both clomiphene (CC) and letrozole are commonly used oral ovulation induction agents, with different mechanism of action. Apart from letrozole or CC, options for ovulation induction in polycystic ovarian syndrome (PCOS) patients are limited and thus leaving the use of gonadotropin injections as the only option of ovulation induction in these patients. The objective of this study is to evaluate the efficacy of combined therapy of letrozole and CC compared to the use of letrozole alone to achieve ovulation in infertile women with PCOS.
Methods: This will be a single-centre, double arm, triple-blind randomized controlled trial. The study was conducted after taking approval from institutional ethics committee and was prospectively registered with the clinical trials registry- India. Women were randomly assigned to receive a combination of 2.5 mg letrozole and placebo daily or a combination of 2.5 mg letrozole and 50 mg CC daily on cycle days 3–7 for one treatment cycle.
Conclusions: If combination of clomiphene and letrozole is proved to be more efficacious than letrozole alone, there will be several breaks through advantages in the management of infertility. The novel method of ovulation induction with combined letrozole and clomiphene will bring down overall cost of infertility treatment.
Trial registration: The study is prospectively registered with the clinical trials registry- India CTRI/2020/09/028012.
Metrics
References
Gonen Y, Casper RF. Sonographic determination of a possible adverse effect of clomiphene citrate on endometrial growth. Hum Reprod. 1990;5:670-4.
Randall JM, Templeton A. Cervical mucus score and in vitro sperm mucus interaction in spontaneous and clomiphene citrate cycles. Fertil Steril. 1991;56:465-8.
Casper RF. Aromatase inhibitors in ovarian stimulation. The J Steroid Biochem Mol Biol. 2007;106:71-5.
Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Open Med. 2010;4:e60-8.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.
Mejia RB, Summers KM, Kresowik JD, Van Voorhis BJ. A randomized controlled trial of combination letrozole and clomiphene citrate or letrozole alone for ovulation induction in women with polycystic ovary syndrome. Fertil Steril. 2019;111(3):571-8.
Roy K, Baruah J, Singla S, Sharma J, Singh N, Jain S, et al. A prospective randomized trial comparing the efficacy of Letrozole and Clomiphene citrate in induction of ovulation in polycystic ovarian syndrome. J Hum Reprod Sci. 2012;5(1):20.
Amer SA, Smith J, Mahran A, Fox P, Fakis A. Double-blind randomized controlled trial of letrozole versus clomiphene citrate in subfertile women with polycystic ovarian syndrome. Hum Reprod. 2017;32(8):1631-8.
Legro RS, Brzyski RG, Diamond MP, Coutifaris C, Schlaff WD, Casson P, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371:119-29.
Liu C, Feng G, Huang W, Wang Q, Yang S, Tan J, et al. Comparison of clomiphene citrate and letrozole for ovulation induction in women with polycystic ovary syndrome: a prospective randomized trial. Gynecol Endocrinol. 2017;33(11):872-6.
Wang R, Li W, Bordewijk EM, Legro RS, Zhang H, Wu X, et al. First-line ovulation induction for polycystic ovary syndrome: an individual participant data meta-analysis. Hum Reprod Update. 2019;25(6):717-32.
Franik S, Eltrop SM, Kremer JA, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2018;5:CD010287.
The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008;23:462-77.
Wang CF, Gemzell C. The use of human gonadotropins for the induction of ovulation in women with polycystic ovarian disease. Fertil Steril. 1980;33:479-86.